Join #TeamCardio today and we'll send you a Cardiomyopathy UK sports top and fundraising pack. As part of #TeamCardio you'll be fully supported in the lead up to your event by our wonderful fundraising team. First Name Last Name Email Mobile fieldset1 Date of Birth Home Address Address Line 2 Address Line 3 Address Line 4 City Post Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSarkSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkmenistanTurks & Caicos IslandsTuvaluTürkiyeU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands fieldset3 What's your connection to cardiomyopathy? fieldset2 - Select -I have cardiomyopathy or a related conditionI am a friend/family member of someone with cardiomyopathyI would like to support the charity in memory of a loved oneCardiomyopathy UK is my employers charityI am a healthcare professionalOther fieldset4 We love to get to know the members of #TeamCardio so feel free to tell us about yourself and your reasons for supporting Cardiomyopathy UK Event Date of event I confirm that I have already secured a place in this event? Yes Running vest/cycling jersey size - Select -XSSMLXLXXL How much are you hoping to raise and is there anything we can do to help you with your fundraising? Would you be interested in sharing your story to support and inspire others? Yes This could be in our My Life magazine, on social media or as part of one of our campaigns. Would you like to receive email updates from us about the latest support and information for people affected by cardiomyopathy, our campaigns, research and ways to get involved?? Yes No I agree to the terms and conditions for own place participants - click here to view. Participation I will inform the fundraising team immediately if I have to withdraw from or cancel my place due to injury or other serious circumstances. Where I am aware of cardiomyopathy or a related condition affecting myself or a family member, or if I have a cardiac device fitted, I understand that Cardiomyopathy UK’s advice is to seek cardiac screening and speak to my doctor before taking part. I understand that this event is organised by the event organiser who is solely responsible for the conduct and operation of the event, including all health and safety requirements. I understand that my participation in the event is conditional upon the event organiser’s terms and conditions. I understand that Cardiomyopathy UK is not responsible for the event and accepts no liability whatsoever in relation to my participation in it. I understand that Cardiomyopathy UK will contact me by phone, email and post to provide everything I need for my chosen event, including fundraising tips and advice, useful updates about the event and training support. I confirm that I will be at least the minimum age required by the event organiser at the date of the event. Fundraising activity I will only use lawful means to fundraise and will not do anything that is likely to bring Cardiomyopathy UK into disrepute. If any funds intended for the charity are raised and paid to me, I will pay it directly to Cardiomyopathy UK through the payment methods they suggest. I will abide by the Fundraising Regulator’s Code of Fundraising Practice I will show the charity any material bearing the Cardiomyopathy UK name or logo, or that discusses the work of the organisation, prior to printing and distribution. Personal data and images I give permission for the free use of my first name, picture, image, feedback and comments in any future fundraising materials and/or promotion conducted by Cardiomyopathy UK. I give permission for my personal information to be stored and used by Cardiomyopathy UK in connection with the organisation and administration of the Event and passed to the Event organisers as required. I understand that Cardiomyopathy UK will process my data in accordance with their Privacy Policy.